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by Dennis Thompson

42 States Reporting Respiratory Virus That Targets Kids

Health officials also investigating whether it's linked to several deaths, cases of muscle weakness, paralysis
WEDNESDAY, Oct. 1, 2014 (HealthDay News) -- Forty-two states and the District of Columbia now have a total of 500 confirmed cases of Enterovirus D68, the severe respiratory illness that has been infecting children since the summer, U.S. health officials reported Wednesday.
Four people infected with the virus have died in recent weeks, but it's not clear what role -- if any -- the virus played in those deaths, officials said.
Health officials are also trying to determine if the virus is associated with cases of muscle weakness and even paralysis that have struck 10 children in the Denver area. Other cases of muscle weakness or paralysis have been reported in Massachusetts, Michigan and Missouri, according to The New York Times.
Doctors don't know if the limb weakness or paralysis is temporary or will be long-lasting -- or whether it has anything to do with Enterovirus D68.
Among the dead children was a 10-year-old Rhode Island girl who died last week after she became infected with the virus and bacteria, Rhode Island and federal health officials said Wednesday.
Her death was caused by a bacterial infection, Staphylococcus aureus, that hit her at the same time as the virus, the Associated Press reported, quoting Rhode Island officials. They called it "a very rare combination," and stressed that most people infected with Enterovirus D68 typically suffer little more than a runny nose and a low-grade fever.
"We're saying we're sure that the child died of staph aureus sepsis, which is an overwhelming bacterial infection. We're sure of that," state Health Director Dr. Michael Fine said Wednesday, the Providence Journal reported.
"The virus was present in the child's body. We're not sure how much the presence of the virus contributed -- or didn't contribute -- to the child's death," he added.
The virus is behind a spike in harsh respiratory illnesses in children that started in early August.
According to the U.S. Centers for Disease Control and Prevention, the 42 states with confirmed cases of Enterovirus D68 are: Alabama, Arkansas, California, Colorado, Connecticut, Delaware, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
So far, almost all of the cases have involved children, the CDC said.
Enterovirus D68 is part of the family of viruses that includes the common cold. It can sometimes require hospitalization, especially for children with asthma.
The CDC said it expects more cases to be confirmed in the coming weeks because the testing for Enterovirus D68 is complex and can only be done by the CDC and a small number of state-run laboratories.
The first cases of Enterovirus D68 were diagnosed in August in Midwestern and Western states.
Enteroviruses are common in September as kids head back to school, with an estimated 10 million to 15 million people infected each year. But doctors believe this particular type of enterovirus is causing more severe cases than in the past.
The virus is also hard to track because it causes symptoms similar to many other infections, including the common cold, according to health experts.
Illness associated with the Enterovirus D68 infection typically lasts about a week. Children will appear to have a severe cold, with runny nose, sneezing and cough. But the illness can escalate quickly in some cases, and the child may start to have trouble breathing. It's typically transmitted through close contact with an infected person, or by touching objects or surfaces contaminated with the virus and then touching the mouth, nose or eyes, according to health officials.
Antibiotics won't work against a virus, and there is no antiviral treatment available for Enterovirus D68, health officials said.
The CDC is asking doctors and public health officials to consider Enterovirus D68 as a potential suspect if widespread respiratory illnesses start occurring in their communities.
Health experts say good hygiene is the best defense against the virus.
Children and adults should wash their hands with soap and water for at least 20 seconds on a regular basis. They also should avoid contact with people who are sick, and stay home if they themselves fall ill. Kids with asthma need to stay on top of their symptoms and take their medication, health officials said.
Enteroviruses are very common, according to the CDC. There are more than 100 types of enteroviruses. People who come down with a bad summer cold often have been laid low by an enterovirus, the agency said.
More information
To learn more about enteroviruses, visit the U.S. Centers for Disease Control and Prevention (http://www.cdc.gov/non-polio-enterovirus/ ).
SOURCES: U.S. Centers for Disease Control and Prevention; The New York Times; Associated Press; Providence Journal
by Dennis Thompson

CDC Confirms First Patient Diagnosed With Ebola in United States

Unidentified man at Dallas hospital developed symptoms days after flying from West Africa
TUESDAY, Sept. 30, 2014 (HealthDay News) -- The first confirmed case of Ebola has surfaced in the United States, involving a man who recently flew here from Liberia, federal health officials announced late Tuesday.
The critically ill patient, being cared for at Texas Health Presbyterian Hospital in Dallas, has been diagnosed with the deadly virus, officials from the U.S. Centers for Disease Control and Prevention said in a late afternoon news conference.
The man is receiving intensive care in isolation at the hospital, said Dr. Edward Goodman, the hospital's epidemiologist. Experimental therapies are being discussed with his family members and his doctors.
This is the first patient ever diagnosed with Ebola in the United States, and the first patient outside Africa to ever be diagnosed with the Ebola Zaire strain, CDC Director Dr. Thomas Frieden noted.
"The bottom line here is that I have no doubt we will control this case of Ebola so it will not spread widely in this country," Frieden said at the news briefing.
He said the man boarded a plane in Liberia on Sept. 19 and arrived in the United States the next day. The patient had no symptoms during his flight, and only fell ill four or five days later.
Frieden stressed there is "zero risk" of Ebola to people who shared the flight, since the virus can only be transmitted by someone suffering from symptoms.
The patient first sought medical care on Sept. 26, Frieden said. Doctors admitted him to the hospital on Sept. 28 and placed him in isolation.
Samples submitted to state and federal health officials tested positive for the Ebola Zaire strain Tuesday, said Dr. David Lakey, commissioner of the Texas Department of State Health Services.
The man was "here to visit family who live in this country," and was staying with family when he fell ill, said Frieden, who declined to say whether he is an American citizen. As far as public health officials know, the man was not involved in the medical response to the ongoing Ebola epidemic in West Africa.
Public health officials are tracking down people who might have come into contact with the patient, Frieden said. Once identified, they will be monitored for fever during the next 21 days, which is the maximum incubation period for Ebola.
Currently, public health officials suspect only a handful of people in Texas came into contact with the patient since he fell ill, including some family members and friends.
"Our approach in these cases is to cast the net widely," to err on the side of safety, Frieden said.
Frieden stressed that Ebola is not easily transmitted -- to become infected, a person must come into direct contact with the bodily fluids of a person who is suffering symptoms.
On Tuesday, the Dallas hospital issued a statement in which it said it was taking all precautions. "The hospital is following all Centers for Disease Control and Texas Department of Heath recommendations to ensure the safety of patients, hospital staff, volunteers, physicians and visitors," the hospital said.
Goodman said that hospital officials had a meeting to discuss how they should respond to an Ebola case just one week prior to the patient's admission.
"Because of that, we were well prepared to deal with this crisis," he said, describing the facility as a "large community hospital with a robust infection control system."
"The issue with Ebola is not that it is highly infectious," Frieden added. "The issue with Ebola is that the stakes are so high."
It "has a high case fatality rate, even with the best of care," he explained. A person receiving medical care has a 50 percent chance of dying, and in some outbreaks the death rate has soared as high as 90 percent.
The new case in Dallas is the sixth to be treated in the United States since the West African outbreak began last spring. An unidentified American doctor who had been working in Sierra Leone is currently being cared for at a hospital at the U.S. National Institutes of Health in suburban Washington, D.C.
Three others who became infected with the virus have recovered, while a fourth continues to undergo treatment at Emory University Hospital in Atlanta.
The Ebola epidemic in West Africa is the worst outbreak ever of the disease. So far, an estimated 6,500 people have become infected and nearly 3,100 have died in the countries of Guinea, Liberia, Nigeria and Sierra Leone, according to the World Health Organization.
The epidemic could strike as many as 1.4 million people by mid-January unless the global community mounts a rapid response to the crisis, according to estimates by the CDC.
More information
For more information on Ebola virus, visit the U.S. Centers for Disease Control and Prevention (http://www.cdc.gov/vhf/ebola/ ).
SOURCES: Sept 30, 2014, news briefing, U.S. Centers for Disease Control and Prevention
by Dennis Thompson

CDC Monitoring Those Who Had Contact With Ebola Patient

Now being treated at Dallas hospital, he developed symptoms days after arriving from West Africa
WEDNESDAY, Oct. 1, 2014 (HealthDay News) -- Federal health officials are monitoring up to 18 people who were exposed to the man being treated at a Dallas hospital for the first confirmed case of Ebola in the United States.
Some of the 18 people are members of the man's family. The group also includes five schoolchildren as well as the three-member ambulance crew that transported the man on Sunday to Texas Health Presbyterian Hospital, according to published reports.
The man has been identified as Thomas Eric Duncan, a Liberian national, who arrived in the United States on Sept. 20 to visit family in the Dallas-Fort Worth area, The New York Times reported.
Duncan may have had contact with the five children at a home in Texas over the weekend. The children attend four different schools, including a high school, a middle school and two elementary schools. The schools will remain open but will undergo a thorough cleaning as a precaution, the newspaper said.
The ambulance workers have tested negative for the highly lethal virus that has been ravaging several West African nations, and are confined to their homes for observation, the Associated Press reported.
"If anyone develops fever, we'll immediately isolate them to stop the chain of transmission," Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, told the AP.
People who had contact with Duncan will be monitored for fever during the next 21 days, which is the maximum incubation period for Ebola, Frieden said.
Duncan flew to the United States from Liberia after quitting his job with a shipping company in Monrovia, Liberia, one of the West African nations battling the Ebola outbreak, the Times reported. He first developed Ebola symptoms Sept. 24 and sought care two days later, but was released from the hospital. Hospital officials weren't aware at the time that he had been in West Africa, the AP reported.
He was taken to Texas Health Presbyterian Hospital after his condition worsened.
Duncan is the first patient ever diagnosed with Ebola in the United States, and the first patient outside Africa to ever be diagnosed with the Ebola Zaire strain, Frieden said at a Tuesday afternoon news briefing.
"The bottom line here is that I have no doubt we will control this case of Ebola so it will not spread widely in this country," Frieden said at the briefing.
Frieden said Duncan had no symptoms during his flight from Liberia, and only fell ill four or five days later.
Frieden said there is "zero risk" of Ebola to people who shared the flight, since the virus can only be transmitted by someone suffering from symptoms.
Frieden stressed that Ebola is not easily transmitted -- to become infected a person must come into direct contact with the bodily fluids of a person who is suffering symptoms. Those symptoms include fever, muscle pain, vomiting and bleeding and can appear as long as 21 days after exposure to the virus.
On Tuesday, the Dallas hospital issued a statement in which it said it was taking all precautions. "The hospital is following all Centers for Disease Control and Texas Department of Health recommendations to ensure the safety of patients, hospital staff, volunteers, physicians and visitors," the hospital said.
The new case in Dallas is the sixth to be treated in the United States since the West African outbreak began last spring. An unidentified American doctor who had been working in Sierra Leone is currently being cared for at a hospital at the U.S. National Institutes of Health in suburban Washington, D.C.
Three others who became infected with the virus have recovered, while a fourth continues to undergo treatment at Emory University Hospital in Atlanta.
The Ebola epidemic in West Africa is the worst outbreak ever of the disease. So far, an estimated 6,500 people have become infected and nearly 3,100 have died in the countries of Guinea, Liberia, Nigeria and Sierra Leone, according to the World Health Organization.
The epidemic could strike as many as 1.4 million people by mid-January unless the global community mounts a rapid response to the crisis, according to estimates by the CDC.
More information
For more information on Ebola virus, visit the U.S. Centers for Disease Control and Prevention (http://www.cdc.gov/vhf/ebola/ ).
SOURCES: Sept. 30, 2014, news briefing, U.S. Centers for Disease Control and Prevention; Associated Press; The New York Times
by Dennis Thompson

'High-Intensity' Hospitals Save More Elderly After Surgery: Study

But downside includes longer hospital stays, fewer days in hospice
WEDNESDAY, Oct. 1, 2014 (HealthDay News) -- Hospitals that pull out all the stops to rescue surgical patients in crisis are slightly better at saving lives, but the cost of such heroism is questionable, a new study suggests.
Highly aggressive hospitals are about 5 percent better at saving elderly patients with life-threatening complications after major surgery, compared with hospitals that operate with less intensity, said senior author Dr. Amir Ghaferi. He is assistant professor of surgery and chief of the Division of Veterans Administration at the University of Michigan Health Systems.
"There was some benefit to being treated at a high-intensity hospital, where patients had a slight improvement in their rescue rates, but it wasn't a huge effect," Ghaferi said.
But these aggressive hospitals have slightly higher rates of major complications and more inpatient deaths, Ghaferi and his colleagues found. Patients tend to remain hospitalized longer in these facilities, and are less likely to turn to hospice during their final years of life.
Hospitals might do better by patients if, instead of throwing resources toward saving those in crisis, they instead focus on detecting and preventing potentially life-threatening complications, Ghaferi said.
"An ounce of prevention is worth a pound of cure. That's exactly the right idea," he said. "You want to catch the problem before that first domino falls, because once that domino falls, it's hard to stop it from progressing from one complication to another and, ultimately, to death."
In this study, published online Oct. 1 in the journal JAMA Surgery, researchers used national Medicare data to identify more than 706,000 patients aged 65 and older who underwent major surgery at over 2,500 hospitals. The investigators noted their outcomes and any major complications.
The researchers then judged each hospital's aggressiveness using measures taken from the Dartmouth Atlas of Healthcare, in particular the Hospital Care Intensity Index. This index evaluates a hospital's willingness to aggressively treat Medicare patients during their last two years of life.
The intensity of care provided by hospitals varied dramatically across the country, with the most aggressive hospitals displaying 10 times the intensity of the most passive hospitals, the researchers found.
Overall, patients who had surgery at an aggressive hospital were 5 percent less likely to die of a major complication.
But the highly aggressive hospitals also:
Ran up higher Medicare costs, charging more than $47,000 per inpatient compared with about $29,500 per inpatient for the least intense hospitals. Kept patients longer, with an average hospital stay of 25 days compared with 16 days for low-intensity hospitals. Had more inpatient deaths -- about 31 percent of all deaths compared with 26 percent in low-intensity hospitals. Were less likely to refer patients to hospice. Patients at low-intensity hospitals spent an average of 19 days in hospice, compared with 17 days for aggressive hospitals.
"This means they are spending their final days and dying in the hospital, rather than being discharged someplace where they can die more peacefully, with their family," Ghaferi said.
Ghaferi hopes the study will promote discussion of how best to use a hospital's resources when caring for people who have undergone major surgery.
Utilization of resources by itself doesn't lead to safer outcomes when it comes to major surgery, he said. "Hospitals need to pay attention not necessarily to how much they're doing as to how they are coordinating that care," he added. "How can we develop a system based on teamwork and cooperation, where we do pick up problems sooner?"
More information
For more information on surgery, visit the U.S. National Institutes of Health (http://www.nlm.nih.gov/medlineplus/surgery.html ).
SOURCES: Amir Ghaferi, M.D., assistant professor, surgery, and chief, Division of Veteran's Administration, University of Michigan Health Systems; Oct. 1, 2014, JAMA Surgery, online
by Dennis Thompson

A Little Booze Does Get Men Smiling, Study Confirms

The liquid social lubricant seems to foster 'contagious' grinning among guys
WEDNESDAY, Oct. 1, 2014 (HealthDay News) -- In perhaps one of the happiest studies ever conducted, scientists confirm what many partygoers know: Just add booze and groups of men start smiling.
The study, reported this week in the journal Clinical Psychological Science, included more than 700 social drinkers in their 20s. It found that drinking significantly boosted "contagious smiling" in groups consisting solely of men, but did not have the same effect when women were on the scene.
"We wanted to explore the possibility that social alcohol consumption was more rewarding to men than to women -- the idea that alcohol might actually 'lubricate' social interaction to a greater extent among men," study author Catharine Fairbairn, a psychological scientist at the University of Pittsburgh, said in a journal news release.
Prior research has shown that men are about 50 percent more likely than women to drink excessively, and a great deal of problem drinking occurs when they're socializing, Fairbairn's team explained.
In fact, "many men report that the majority of their social support and social bonding time occurs within the context of alcohol consumption," Fairbairn said.
Her team looked at the behavior of 720 social drinkers, aged 21 to 28, who were divided into groups of three sitting around tables. Each group was served either an alcoholic drink (vodka and cranberry juice) or a non-alcoholic drink they had been told was alcoholic -- the researchers smeared the outside of the glass with vodka to give the illusion that it was a "real" vodka/cranberry cocktail.
Drinking the real booze was tied to a significant rise in the amount of smiling among any all-male groups, the researchers report, but it did not have the same effect when groups included any women.
According to Fairbairn's team, the results suggest that alcohol appears to make smiles more "contagious" between men when they're socializing, making them more socially "brave." The study also found that the heavier a drinker a man was, the more susceptible he was to "contagious smiling" in all-male groups.
Fairbairn believes the research could give insight into problem drinking, not just everyday social tippling.
"Historically, neither the scientific community nor the general public has been terribly concerned about drinking that occurs in social settings," she said. "According to popular opinion, a 'social drinker' is necessarily a non-problem drinker, despite the fact that the majority of alcohol consumption for both light drinkers and problem drinkers occurs in a social context."
More information
The U.S. National Institute on Alcohol Abuse and Alcoholism has more about alcohol consumption (http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption ).
SOURCE: Clinical Psychological Science, news release, Sept. 30, 2014
by Dennis Thompson

Could a Fading Sense of Smell Point to Earlier Death?

Study found inability to distinguish odors predicted higher odds of dying over next 5 years
WEDNESDAY, Oct. 1, 2014 (HealthDay News) -- Older adults who have trouble smelling the roses -- literally -- may face an increased risk of dying in the next several years, new research suggests.
In a study of over 3,000 older Americans, researchers found those who were unable to detect scents such as rose, orange and peppermint were more than three times as likely to die in the next five years, versus those with a sharp sense of smell.
In fact, anosmia -- the inability to distinguish odors -- was a bigger predictor of death than major killers such as heart disease, lung disease or cancer, the researchers reported Oct. 1 in the online journal PLOS One.
"We were pretty surprised it was such a strong predictor," said lead researcher Dr. Jayant Pinto, a surgeon at the University of Chicago who specializes in nasal disorders.
Now, the question is why. No one is saying anosmia itself kills people, stressed Pamela Dalton, a researcher at the nonprofit Monell Chemical Senses Center in Philadelphia.
"There's no need for people to be scared," said Dalton, who wasn't involved in the study. But, she said, the findings are important, because they suggest that problems with smell detection can sometimes be a "harbinger" of health issues to come.
According to the U.S. National Institutes of Health, 1 to 2 percent of North Americans have trouble detecting scents. In some cases, Dalton said, there is a specific cause, such as benign growths in the nasal cavity, a head injury, or -- for a small number of people -- lasting effects from a respiratory infection.
But aging is the main culprit behind loss of smell, Pinto said.
Up to one-quarter of men in their 60s, and 11 percent of women, may have a "smell disorder," according to the Institutes of Health.
In Pinto's study, however, age didn't explain the link between anosmia and death risk.
Neither did other risk factors for smell loss, such as smoking and heavy drinking. The researchers also accounted for major diseases, including heart disease, stroke, cancer, diabetes and lung disease, as well as study participants' performance on a test of memory and thinking skills.
Other research has found that problems with scent detection can precede mental decline and dementia, Pinto explained. "Interestingly enough," he said, "when we controlled for [mental] decline, we still saw this association" between smell loss and death risk.
The findings are based on 3,005 U.S. adults ages 57 to 85 who were asked to identify five odors: rose, orange, peppermint, leather and fish.
Overall, 78 percent correctly named at least four, and were considered to have a normal sense of smell. Another 20 percent identified two or three scents; close to 4 percent sniffed out no more than one scent, and were considered to have anosmia.
Over the next five years, 39 percent of people with anosmia died, versus 19 percent of those with moderate smell loss, and 10 percent of those with a healthy sense of smell.
So what's going on? One theory, Pinto said, is that a poor sense of smell is associated with lifetime exposure to toxins such as on-the-job chemicals or air pollution.
Pinto explained that the olfactory nerve, which carries scent information to the brain, is the only one of the cranial nerves that is directly exposed to the environment.
He also noted that, unlike our other senses, the sense of smell depends on a constant turnover of primitive cells called stem cells.
"In theory," Pinto said, "[anosmia] could be an indicator that the body's overall regenerative capacity is in decline."
He said more research is needed to understand the reasons for the findings, and to see whether smell loss is linked to particular causes of death.
For now, Pinto said, "I hope this raises awareness that our sense of smell is important."
Problems with smell can be subtle, and people may only realize something is wrong when they can no longer taste and enjoy food, Pinto said. "If you notice a problem, tell your doctor," he advised. If the cause of the smell loss is treatable, that should improve your quality of life, Pinto said.
Dalton agreed, and said she'd like to see doctors routinely evaluate people's sense of smell, just as they check vision and hearing.
More information
The U.S. National Institutes of Health has more on smell disorders (http://www.nidcd.nih.gov/health/smelltaste/pages/smell.aspx ).
SOURCES: Jayant Pinto, M.D., associate professor, surgery, University of Chicago, Ill.; Pamela Dalton, Ph.D., M.P.H., researcher, Monell Chemical Senses Center, Philadelphia, Pa.; Oct. 1, 2014, online PLOS One
by Dennis Thompson

Experimental Cervical Cancer Vaccine Looks Promising in Trial

Research suggests the HPV shot could prevent 90 percent of malignancies
WEDNESDAY, Oct. 1, 2014 (HealthDay News) -- An experimental vaccine meant to protect against nine types of human papillomavirus (HPV) could prevent 90 percent of all cervical cancers, a new study suggests.
Researchers examined data from more than 2,500 women with precancerous cervical lesions and found that nearly all were caused by the nine types of HPV targeted by the vaccine being developed by Merck and Co.
The new vaccine, currently undergoing clinical trials, protects against more types of HPV than current vaccines, according to the study published Oct. 1 in the journal Cancer Epidemiology, Biomarkers & Prevention.
"We wanted to study how many cervical precancers could potentially be prevented by an investigational nine-valent HPV vaccine that provides protection against the HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58," Dr. Elmar Joura, an associate professor of gynecology at the Medical University of Vienna in Austria, said in a journal news release.
"Given the high vaccine efficacy that was observed in a large phase III clinical trial testing the nine-valent HPV vaccine, if vaccination programs with this new-generation vaccine are effectively implemented, approximately 90 percent of invasive cervical cancer cases worldwide could be prevented, in addition to the majority of precancerous lesions," he said.
Of the women aged 15 to 26 with precancers, about one-third were infected with more than one HPV type, the researchers said. Of women aged 24 to 45 with precancers, nearly one in five was infected with more than one HPV type, the investigators found.
HPV, which is spread through sexual contact, not only can lead to cervical cancer, but also cancers of the vulva, vagina and anus in women. In men, it can lead to cancers of the anus and penis.
The study was funded by Merck. Joura has received grant support to his institution, as well as advisory board and lecture fees from Merck and other drug companies.
Joura noted that even though current HPV vaccines (Gardasil and Cervarix) are known to be safe, their use in the United States and other wealthy nations has been "inadequate." He said the use of HPV vaccines must increase if their full potential to reduce cervical cancer is to be achieved.
More information
The U.S. National Cancer Institute has more about HPV vaccines (http://www.cancer.gov/cancertopics/factsheet/Prevention/HPV-vaccine ).
SOURCE: Cancer Epidemiology, Biomarkers & Prevention, news release, Oct. 1, 2014
by Dennis Thompson

Free, Long-Acting Contraceptives May Greatly Reduce Teen Pregnancy Rate

Study findings also showed abortion rate was three-quarters lower than the national norm in this age group
WEDNESDAY, Oct. 1, 2014 (HealthDay News) -- Giving teenage girls free birth control -- especially long-acting implanted devices -- could slash pregnancy and abortion rates to well below the current U.S. average, new findings suggest.
In a study of 1,400 teenage girls, researchers found that counseling and free contraceptives substantially cut the girls' rates of unplanned pregnancy and abortion. Over three years, their annual pregnancy rate averaged 34 per 1,000 girls -- versus a rate of 158 per 1,000 among all sexually active teenage girls in the United States.
Meanwhile, the abortion rate was 9.7 per 1,000 girls in the study, compared to a national abortion rate of 41.5 per 1,000 sexually active girls, the researchers report in the Oct. 2 issue of the New England Journal of Medicine.
"What we're seeing here are extraordinary declines," said Bill Albert, chief program officer for the Washington, D.C.-based National Campaign to Prevent Teen and Unplanned Pregnancy.
Albert, who was not involved in the research, pointed to a key element of the study: Girls received counseling that emphasized the safety and effectiveness of intrauterine devices (IUDs) and contraceptive implants -- and most of the teens opted for those types of birth control.
IUDs and implants are substantially more effective than the Pill or condoms, which are currently the top birth control choices among U.S. teens, according to the American Academy of Pediatrics (AAP).
The "magic" of IUDs and implants, according to Albert, is that they are put in place and then last for years -- or until a woman decides to remove them. "These types of birth control are 'set it and forget it,'" Albert said. "They don't rely on perfect use."
And from the standpoint of preventing unplanned pregnancies, the devices "have the potential to be game-changing," Albert said.
The new report comes on the heels of new recommendations from the AAP, advocating IUDs and implants as the first-choice contraceptives for teenagers.
Gina Secura, the lead researcher on the new study, welcomed the AAP guidelines, which came out this week.
"For so long we've dismissed these types of contraceptives for teenagers, thinking girls won't want them or will find them too complicated," said Secura, a researcher at Washington University School of Medicine in St. Louis.
But, she said, her team's findings show that teenagers are willing to use IUDs and implants. Even more importantly, she added, the benefits are clear.
According to Planned Parenthood, IUDs are implanted in the uterus, where they release small amounts of either copper or the hormone progestin. The contraceptive implant, about the size of a matchstick, is inserted under the skin of the arm, where it releases controlled amounts of progestin.
The hormonal IUD (sold under the brand name Mirena) can prevent pregnancy for five years, while the copper version (ParaGard) works for about 10 years. The contraceptive implant (Implanon, Nexplanon) lasts for three years, according to Planned Parenthood.
According to the U.S. Centers for Disease Control and Prevention (CDC), between 0.2 percent and 0.8 percent of women who use an IUD will have an unplanned pregnancy within a year. That rate is just 0.05 percent with an implant.
In contrast, about 9 percent of women on the Pill have an unintended pregnancy each year. Condoms, as people typically use them, are even less effective -- with a pregnancy rate of 18 percent to 21 percent, according to the CDC.
Still, only about 5 percent of U.S. teens currently use IUDs or implants, according to background information in the study. Secura said that going into this study, her team thought price was the major obstacle: IUDs cost $500 to $1,000 upfront, while contraceptive implants range from $400 to $800.
But the researchers quickly found out that many young women simply don't know much about the devices.
Albert said that to translate these study findings to the real world, doctors and other providers are going to have to get up-to-date with the evidence for IUDs and implants -- and either become comfortable with offering the devices, or be able to refer girls to a provider who is.
Planned Parenthood welcomed the new findings.
"This study shows that the IUD and implant help reduce teen pregnancy," said Dr. Vanessa Cullins, vice president of external medical affairs for Planned Parenthood Federation of America. "IUDs and implants are safe for most women, including adolescents and women who have not yet children, and they are an especially good option for young women who want to delay starting their families for a few years, so they can be the best parents they can be."
As for cost, under the Affordable Care Act, many insurers have begun covering prescription birth control methods without copays.
"Hopefully," Albert said, "the cost of IUDs and implants will become less of a concern."
Still, Secura said, teens can face an extra obstacle: wanting to keep their contraception choice private. State laws on minors' access to contraception vary. But even when teens can get it on their own, their parents will probably find out when they receive their insurer's explanation of benefits, Secura pointed out.
Albert said that ideally, kids should feel they can talk to their parents. "Parents and kids should have discussions about relationships, sex and contraception -- early and often," he said.
He added that, despite some parents' worries, those talks do not end up encouraging kids to have sex. "Research shows that's a myth," Albert said. "When parents discuss these issues, their kids tend to delay sex. And when they do have sex, they're more likely to use contraception."
More information
The U.S. Department of Health and Human Service has more on birth control methods. (http://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html )
SOURCES: Gina Secura, Ph.D., M.P.H., senior scientist, obstetrics and gynecology, Washington University School of Medicine, St. Louis, Mo.; Bill Albert, program director, National Campaign to Prevent Teen and Unplanned Pregnancy, Washington, D.C.; Oct. 2, 2014, New England Journal of Medicine
by Dennis Thompson

Gene Study Finds No Proof Vitamin D Guards Against Type 2 Diabetes

Some past research had suggested a possible benefit against the disease
TUESDAY, Sept. 30, 2014 (HealthDay News) -- There's no genetic evidence that high levels of vitamin D can prevent type 2 diabetes, a new study says.
Some previous research had suggested that elevated levels of vitamin D might protect people against type 2 diabetes, raising the possibility of a link between vitamin D deficiency and the blood sugar disease.
In this study, British researchers investigated the association between diabetes risk and vitamin D by focusing on genes that control blood levels of vitamin D. They found no connection between different variants of these genes and the risk of developing type 2 diabetes.
The results were published Sept. 30 in The Lancet Diabetes & Endocrinology.
"Our findings suggest that interventions to reduce the risk of type 2 diabetes by increasing concentrations of vitamin D are not currently justified. Observational studies that show a strong and consistent higher risk of type 2 diabetes with lower levels of vitamin D may do so because they have thus far not been able to adequately control for distorting or confounding factors, such as physical activity levels," study author Dr. Nita Forouhi, of the University of Cambridge's School of Clinical Medicine, said in a journal news release.
The findings add to evidence showing that taking vitamin D supplements does not prevent diabetes. The only proven ways to prevent type 2 diabetes are diet and exercise, Forouhi said.
One expert noted that long-term trials that are still looking at any possible connection should be weighed in the final analysis.
The results "need careful interpretation, and long-term randomized trials of vitamin D supplementation, which are underway, remain important," Dr. Brian Buijsse, from the German Institute of Human Nutrition Potsdam-Rehbruecke in Germany, wrote in an accompanying commentary in the journal.
"The results of an [analysis] of 35 short-term trials, however, do not offer much hope that vitamin D supplementation can be used to prevent type 2 diabetes. The sky is becoming rather clouded for vitamin D in the context of preventing type 2 diabetes," he said.
More information
The U.S. Office of Disease Prevention and Health Promotion explains how to prevent type 2 diabetes (http://www.healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/take-steps-to-prevent-type-2-diabetes ).
SOURCE: The Lancet Diabetes & Endocrinology, news release, Sept. 30, 2014
by Dennis Thompson

Genes May Make Some More Prone to Heart Disease When Under Stress

Lifestyle changes could make big difference for people with a genetic risk, researchers say
WEDNESDAY, Oct. 1, 2014 (HealthDay News) -- Genes may interact with stress to trigger heart disease in some people, a new study suggests.
The genetic risk occurs in about 13 percent of people, but only in those who are white. The finding could help these people reduce their heart disease risk through simple measures such as exercise, a healthy diet and stress management, the Duke University researchers said.
The study authors analyzed genetic data from nearly 6,000 people and found a strong link between variations in the EBF1 gene and higher levels of central obesity, as measured by hip circumference. In people with these gene variations, their hips grew wider as their stress levels increased.
Further investigation revealed a "significant pathway" to high blood sugar levels, diabetes and heart disease, most notably a narrowing of the arteries.
"These findings suggest that a stress reduction intervention, along with diet and exercise, could reduce the risk of cardiovascular disease and may be most effective in individuals with this specific genotype," study co-senior author Dr. Redford Williams, director of Duke's Behavioral Medicine Research Center, said in a university news release.
While the research found an association between genes, stress and heart disease, it did not prove a cause-and-effect link.
The study was published online Oct. 1 in the European Journal of Human Genetics.
"We need to figure out how these genetic factors influence the increased accumulation of fat in the central body and increased blood glucose levels in persons exposed to high life stress, and why there are also differences with ethnicity," study co-senior author Elizabeth Hauser, director of computational biology at the Duke Molecular Physiology Institute, said in the news release.
"This knowledge could help identify targets for behavioral and drug interventions that could reduce disease risk," she added.
More information
The U.S. National Institutes of Health explains how to reduce heart risks (http://newsinhealth.nih.gov/issue/Feb2012/Feature1 ).
SOURCE: Duke University, news release, Oct. 1, 2014

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